Stoker J, Romijn M G, de Man R A, Brouwer J T, Weverling G J, van Muiswinkel J M, Zondervan P E, Laméris J S, Ijzermans J N M
Department of Radiology, Erasmus Medical Centre Rotterdam, University of Amsterdam, The Netherlands.
Gut. 2002 Jul;51(1):105-7. doi: 10.1136/gut.51.1.105.
Hepatocellular carcinoma (HCC) is often detected at a relatively late stage when tumour size prohibits curative surgery. Screening to detect HCC at an early stage is performed for patients at risk.
The aim of this study was to compare prospectively the diagnostic accuracy and classification for management of the two state of the art secondline imaging techniques: triphasic spiral computer tomography (CT) and super paramagnetic iron oxide (SPIO) enhanced magnetic resonance imaging (MRI).
Sixty one patients were evaluated between January 1996 and January 1998. Patients underwent CT and MRI within a mean interval of 6.75 days.
CT and MRI were evaluated blindly for the presence and number of lesions, characterisation of these lesions, and classification for management. For comparison of the data on characterisation, the CT and MRI findings were compared with histopathological studies of the surgical specimens and/or follow up imaging. Data of patients not lost to follow up were available to January 2001.
SPIO enhanced MRI detected more lesions and overall smaller lesions than triphasic spiral CT (number of lesions 189 v 124; median diameter 1.0 v 1.8 cm; Spearman rank's correlation coefficient 0.63, p<0.001). There was no significant difference in accuracy between CT and MRI for lesion characterisation. The agreement in classification for management was very good (weighted kappa 0.91, 95% CI 0.83-0.99).
SPIO enhanced MRI detects more and smaller lesions, but both techniques are comparable in terms of classification for management. SPIO enhanced MRI may be preferred as there is no exposure to ionising radiation.
肝细胞癌（HCC）常在肿瘤大小已无法进行根治性手术的相对晚期被发现。对有风险的患者进行筛查以早期发现HCC。
本研究的目的是前瞻性比较两种先进的二线成像技术的诊断准确性及管理分类：三相螺旋计算机断层扫描（CT）和超顺磁性氧化铁（SPIO）增强磁共振成像（MRI）。
1996年1月至1998年1月期间对61例患者进行了评估。患者在平均间隔6.75天的时间内接受了CT和MRI检查。
对CT和MRI进行盲法评估，包括病变的存在和数量、这些病变的特征以及管理分类。为比较特征数据，将CT和MRI的结果与手术标本的组织病理学研究和/或随访成像进行比较。至2001年1月可获得未失访患者的数据。
SPIO增强MRI检测到的病变比三相螺旋CT更多，且总体病变更小（病变数量189个对124个；中位直径1.0 cm对1.8 cm；Spearman等级相关系数0.63，p<0.001）。CT和MRI在病变特征的准确性方面无显著差异。管理分类的一致性非常好（加权kappa 0.91，95%可信区间0.83 - 0.99）。
SPIO增强MRI检测到的病变更多且更小，但两种技术在管理分类方面具有可比性。由于不涉及电离辐射，SPIO增强MRI可能更受青睐。
